GI Flashcards
before birth… what provides nutrients and handles waste?
placenta
no absorption or excretion from GI until after delivery
is the GI tract structurally complete at birth?
yep but its immature
at what age does sucking and swallowing become voluntary?
6 weeks
newborn has small stomach capacity and rapid peristalsis, what should their feedings be like?
small and frequent
describe the deficiencies in digestive enzymes until 4-6mo of age
- deficient in amylase, lipase, and tripsin
- leads to abdominal distention and gas
why is regurgitation a common finding in newborns?
relaxed cardiac sphincter
what liver functions are immature in newborns
- gluconeogenesis: formation os glycogen from noncarbs
- deamination: removal of amino group from amino compound
- vitamin storage
- ketone formation
- plasma protein function immature until 1 year
describe how the stomach capacity increases
- birth: 10-20ml (marble sized)
- 1 month: 30ml or one ounce
- 12mo: 360ml or 8ounces
- 24mo: 500ml or three time a day feeding capacity
at what age do children have control for three meals a day with excretory control?
age 2
what are some signs and symptoms of GI disorders
- inability to gain weight or weight loss
- vomiting, diarrhea, constipation
- lack of energy - lethargy
- abdominal distention or tenderness
describe cleft palate
- failure of maxillary processes to fuse
- clefts of the hard palate from a continuous opening between mouth and nasal cavity
- may be unilateral or bolateral and may involve just the soft palate or both soft and hard palate
when does the palate close during gestation
5th and 12th week
when is cleft palate/lip generally diagnosed?
prenatally, ultasound as early as 13wks
how is clinical confirmation of cleft palate done
ultrasound and palpation of the palate with a finger
describe cleft lip
- can occur alone or with cleft palate
- incomplete cleft lip has a bridge of tissue connecting the central and leteral lip
- varying degrees of nasal deformity may also be present
what are some possible causes of cleft lip and palate
- maternal use of tobacco/alc
- use of anticonvulsants, valproic acid, carbamazapine
- steroid use during pregnancy
- combination of envirnmental and genetic factors
- increased incidence in Native Americans and Asians
- increased incidence and fam history
what are some pre op nursing interventions for cleft lip/palate
- assessments every 2 hours with VS
- suction and bulb syringe at bedside
- provide emotional support to fam
- assess daily weight
- position infant on back
- education with fam on signs and symptoms of resp distress
when is cleft lip usually repaired?
at 3-5months
early repair facilitates easier feeding and speech
may require additional surgeries depending on severity
when is cleft palate usually repaired?
9 and 12months
this protects tooth buds and allows development of normal speech patterns
may require additional surgeries depending on severity
what education is important to include regarding feeding with cleft lip/palate
- bulb syringe available
- feed sitting upright
- hold upright for 30min after feeds
- burp frequently: after 15-30ml of formula
- use of cleft lip/palate special nurser bottle
describe cleft lip/palate post op nursing care
- assessments especially resp status
- VS
- maintain suture line
- pain meds
- feeding/nutrition/I+O
- education with fam
describe maintaining the suture line regarding cleft lip/palate post op nursing care
- position on back only
- soft elbow immobilizers
- antibiotic ointment to suture line as ordered
- keep comfy and content
- no pacifiers, straws, metal sppons or forks
- cleanse with water or NS after feedings
describe feeding and nutrition regarding cleft lip/palate post op nursing care
- dropper, syringe or special nurser bottle
- sit upright
- frequent burping
- 5-15ml of water after feeds
describe homegoing education for cleft lip/palate
- teach family to swaddle the infant at home to protect surgical site
- identify and address homecare needs well in advance of discharge
- discuss all aspects of care throughout hospitalization and after surgery
- involve parents in care to increase comfort before discharge
- teach feeding techniques
- recognize signs of infection
- how to position and care for suture line
- discusss financial implications of long term care
what is pyloric stenosis
- hypertrophy of the pyloric muscle, which is between the stomach and duodenum
- the hypertrophy obstructs the pyloric canal
- the pyloric area become obstructed and inflamed until obstruction becomes complete
- as it ptogresses, vomiting become forceful and projectile and infant becomes dehydrated
what is the peak age for pyloric stenosis
3-5 wks
whats clinical therapy for pyloric stenosis
- abdominal ultrasound confirms diagnosis
- surgical correction: pylormyotomy-pyloric muscle is split
what symptoms are expected with pyloric stenosis
- good eater who vomits occasionally
- multiple formula changes
- projectile vomiting
- infant hungry after emesis
- failure to gain weight
- abnormal stools
- dehydration
- metabolic alkalosis
- peristaltic waves acreoss abdomen
- olive size mass in RUQ
preoperative management of pyloric stenosis includes…
- NPO
- I+O
- maintain IV therapy
- assessments
- insert and monitor NG tube (low intermittent suction)
- correct fluid and electrolyte imbalance
- emotional support to fussy, irritable baby
- provide support to family
describe post op nursing management of pyloric stenosis
- assessments and vital signs frequently
- wound assessment: steri strips or collodion (look for signs and sx of infection)
- feedings begun per surgeons orders
- small amount f clear liqs first then advance volume and strength
- if infant vomits, next feed is decreased
- pain assessments (FLACC)
- family education